Erectile Dysfunction (ED): Symptoms, Causes, and Treatment

Erectile dysfunction (ED) is the inability to get or keep an erection firm enough to have sexual intercourse. It’s sometimes referred to as “impotence,” but this term is now used less often.

ED can occur because of problems at any stage of the erection process, and it can be occasional or frequent:

• Occasional ED isn’t uncommon. Many people experience it during times of stress or as the result of a recent nutritional or lifestyle change.
• Frequent ED, however, can be a sign of health problems that need treatment. It can also be a symptom of emotional or relationship difficulties that you may want to address with a professional.

There are many possible causes of ED, and they can include both emotional and physical conditions. Common physical causes include:

Common emotional causes include:

ED can be caused by only one of these factors or by several of them. That’s why it’s important to work with your doctor so that they can rule out or treat any underlying medical conditions. Learn more about the causes of ED.

Trouble getting an erection and difficulty maintaining an erection during sexual activities are the most common symptoms of erectile dysfunction.

Other sexual disorders related to ED include:

Speak with your doctor if you have any of these symptoms, especially if they’ve lasted for 3 or more months. They can help determine whether your symptoms are caused by an underlying condition that requires treatment.

The prevalence of ED increases with age. The University of Wisconsin estimates that mild or moderate ED affects 10% more men for each decade of life. For example, 60% of men in their 60s might experience some form of ED.

However, ED can also occur among younger people. One 2013 study found that 1 in 4 men seeking their first treatment for ED was under 40 years old. Researchers observed a stronger correlation between smoking, drug use, and ED in these men when compared with older men. This suggests that lifestyle choices are an important factor for ED in younger men.

Although the risk of ED increases with age, ED isn’t inevitable. In general, the healthier you are, the better your sexual function. Learn more about aging and ED.

Testing for ED can involve a variety of steps, including a physical examination and examining your health and sexual history. Your doctor may order additional tests to determine if your symptoms are caused by an underlying condition.

• listen to your heart and lungs
• check your blood pressure
• examine your testicles and penis
• looks for signs of reduced blood in the pelvic region
• check nerve function in the pelvic region

Your doctor will ask you questions or request that you fill out a questionnaire about your symptoms, health history, and sexual history. The responses can help them evaluate the severity of your ED.

Some questions that they may ask include:

• How long have you been experiencing ED? Did it come on suddenly or gradually?
• Are you having any problems with feeling sexual desire, ejaculating, or reaching orgasm?
• How often do you have sex? Has this frequency changed recently?
• How firm are your erections? Is this affected by particular situations or types of stimulation?
• Do you wake up in the morning or in the middle of the night with erections?
• How’s your current relationship? What expectations do you and your partner have for each other? Have there been any changes?
• Have you recently been experiencing a lot of stress?
• What medications are you currently taking? Do you use tobacco, alcohol, or nonprescription drugs?
• Do you have any underlying conditions or have you had any surgery on or injury to your pelvic area?

Your doctor may perform additional testing to help diagnose your ED. Tests can include:

• Ultrasound: An ultrasound can be used to examine the blood vessels of the penis to determine if there’s a problem with penile blood flow.
• Nocturnal penile tumescence test: A portable, battery-powered device is used to evaluate the quality of your nocturnal erections. The device is worn on the thigh. It stores data your doctor can access later. However, it’s not used as often today as it had been in the past.
• Injection test: During this test, a medication is injected into your penis to stimulate an erection. This allows your doctor to evaluate the firmness of the erection and how long it lasts. This type of test can also be combined with ultrasound to further asses the erection.
• Urine tests: Urine tests can check for diabetes or other underlying health conditions.
• Blood tests: Blood tests can check for conditions such as diabetes, heart disease, thyroid issues, and low levels of testosterone.

Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy.

Your doctor may prescribe medication to help you manage the symptoms of ED. You may need to try several medications before you find one that works. The following oral medications stimulate blood flow to your penis to help treat ED:

Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository, or as a self-injection at the base or side of the penis.

In most cases, however, alprostadil is not used alone as an injection, and the combination drug Trimix (alprostadil, phentolamine, papaverine) is used instead.

Medications used for other conditions may cause ED as well. Talk with your doctor about your medications and whether they could be causing ED symptoms.

Your doctor may be able to prescribe other medications. It is also important to note that you should not stop taking any prescribed medications without first talking with your doctor.

Medications for ED can cause side effects or interact badly with any medications you may already be taking. If you’re experiencing unpleasant side effects, talk with your doctor. They may be able to recommend a different medication.

Additionally, some cardiac medications can have very serious side effects if taken with some ED medications. For this reason, it’s very important to share with your doctor the names and dosages of every medication you’re taking before beginning anything new.

You can find and purchase ED medications online, including Viagra, Cialis, and generic versions as well. Here are our roundups of the best places to buy these medications online:

A number of psychological factors can cause ED, including:

If you’re experiencing psychological ED, you may benefit from talk therapy. Over several sessions, you and your therapist will discuss:

• major stress or anxiety factors
• your feelings around sex
• subconscious conflicts that could be affecting your sexual well-being

This treatment uses the creation of a vacuum to stimulate an erection. Using the device draws blood into the penis, leading to an erection.

A vacuum pump device consists of a few different components:

• a plastic tube, which you place over your penis
• a pump, which works to create a vacuum by drawing air out of the plastic tube
• an elastic ring, which you’ll move to the base of your penis as you remove the plastic tube

The elastic ring functions to maintain the erection, holding the blood in the penis and preventing it from returning to circulation. You can leave it in place for 30 minutes.

Since ED medications like Cialis and Viagra require prescriptions, you will need to talk with a doctor in order to purchase these medications online. Thankfully, many reputable online services can connect you with a prescribing doctor or medical professional and ship your ED medications directly to your home. Here’s a quick look at some of the companies that we recommend.

Certain exercises can also help with ED.

Kegel exercises are simple movements you can do to strengthen your pelvic floor muscles. Here’s how:

1. Identify your pelvic floor muscles. To do this, stop peeing midstream. The muscles you use to do this are your pelvic floor muscles.
2. Now that you know where these muscles are, contract them for 3 seconds. Then release them.
3. Repeat this exercise 10 to 20 times in a row, three times per day.

A small 2005 study compared two groups of men with ED. The first group of men performed regular pelvic floor muscle exercises with a physiotherapist. They also received biofeedback and advice on lifestyle changes. The second group only received advice on lifestyle changes.

Men in the first group saw their penile function improve significantly after 3 months of regular pelvic floor muscle exercises. Men in the second group saw little improvement after 3 months.

For the next 3 months, all participants were given at-home exercises to perform. After 6 months in total, 40% of all participants, including some men who had belonged to the second group, had regained normal erectile function.

A 2019 literature review also concluded that pelvic floor exercises were effective at treating both ED and premature ejaculation. However, the researchers didn’t identify an ideal exercise plan in terms of conditions such as frequency and intensity.

You may find that it’s easier initially to do Kegels while lying down. Eventually, you can start trying them when you’re sitting or standing.

Moderate to vigorous exercise is not only good for your overall health. It also can increase blood flow, possibly helping with ED. Examples include running and swimming.

A 2018 review of 10 studies examined the effect of aerobic exercise on ED. From their review, investigators concluded that 160 minutes of weekly exercise for 6 months could lead to a decrease in erectile problems.

Another 2018 study examined physical fitness and testosterone levels in 87 men with ED. Researchers found that testosterone levels were negatively correlated with levels of body fat and abdominal fat. This suggests that exercise may increase testosterone in addition to reducing body fat.

Before you start a new exercise plan, always discuss it with your doctor. This is particularly important for people with heart disease or another underlying condition that could be aggravated by vigorous activity. Learn more about exercise and ED.

Yoga can help to relax your mind and body. Since stress or anxiety can cause or contribute to ED, practicing yoga may be an effective way to ease ED symptoms.

ED is often related to problems with blood flow. Maintaining your blood vessel health may be beneficial in both preventing and treating ED. You can achieve this by making certain lifestyle choices, such as eating a healthy diet.

For some people, natural remedies may help treat ED.

Acupuncture is a type of traditional Chinese medicine in which needles are inserted into the skin at specific locations or acupoints. Acupuncture is believed to work through nerve stimulation, which then affects the release of neurotransmitters.

It’s unclear how acupuncture works to treat ED. Studies on its effectiveness are limited, and those that do exist are often inconclusive.

Findings from a 2019 research review suggest that acupuncture may help treat psychological ED, but more studies are needed to confirm its effectiveness.

In cases where medications aren’t effective, your doctor may recommend surgical treatment. Two types of procedures may be used: implants and vascular surgery.

A surgeon can place a penile implant, also referred to as a prosthesis, in the penis.

There are two implant types:

• An inflatable implant allows you to use a pump to make your penis larger.
• A malleable implant allows you to adjust the position of your penis manually.

Penile implants are typically reserved for severe ED that has been unresponsive to traditional ED treatments. Satisfaction and complication rates can vary among participants and could even lead to someone choosing to have the implant removed in some cases.

If you’re considering a penile implant, it’s worth talking with your doctor in detail about what you can expect from the surgery.

Vascular surgery repairs arteries that may be blocked. This type of surgery is rare, and usually only reserved for people with pelvic trauma that leads to vascular injury.

This type of surgery can help to restore adequate blood flow to the penis. Younger people are typically better candidates for this type of procedure.

Every surgery has its benefits and drawbacks. Be sure to discuss these with your doctor if you decide to undergo surgery for ED.

If you are experiencing ED, it can be difficult to talk about it openly with your partner. However, ED is actually more common than you might think. Consider talking with your doctor so they can more accurately diagnose your symptoms.

It’s not uncommon to lose an erection from time to time, especially during periods of increased stress or sudden changes to your diet or lifestyle. But if you’re unable to have or keep an erection frequently over a few weeks, it’s worth contacting your doctor.

In some cases, your symptoms may not actually be stemming from ED but could be symptoms of another medical condition. Your doctor can run a series of tests and evaluations to screen for those medical conditions and ultimately rule them out as potential causes.

The symptoms of ED can be very frustrating and even embarrassing at times, but many resources are available that can help. If you are concerned that you may be experiencing ED, reach out to your doctor to frankly and honestly discuss your options.

In many cases, you can improve your ED symptoms. Many medications and treatments are available. Certain devices, such as vacuum pumps, can also help you temporarily manage your symptoms so that you can continue to engage in sexual intercourse.

Your treatment plan will depend on a variety of factors, including the severity of your ED and whether it’s caused by a specific health condition. Your doctor will work closely with you to explain the benefits and risks associated with each type of treatment.

It’s important to remember that ED is a common condition. If you’re experiencing symptoms of ED, discuss them with your doctor as soon as possible. That way, they can rule out underlying causes and begin a treatment plan.